Patient movement detection system and method

ABSTRACT

A monitoring system and method tracks a patient&#39;s position over time and ensures that proper turning or other manipulation is done within the time prescribed. Preferably, the techniques herein continuously monitor patient position and alert medical or other personnel of the need for turning or other patient manipulation. The system may be implemented within a medical or other care facility, or within a patient&#39;s home.

RELATED APPLICATIONS

This application is based on and claims priority from Ser. No.61/162,992, filed Mar. 24, 2009, and from Ser. No. 61/162,993, filedMar. 24, 2009.

BACKGROUND

Patients who suffer from conditions such as epilepsy, asthma, chronicheart disease, Alzheimer's, and other conditions with unpredictableoutcomes may need to be constantly monitored for timely assistance andsafety. Additionally, patients who suffer from conditions that requireperiodic shifting of their body orientation in order to preventdigression of the condition or to promote healing from the condition mayalso need to be constantly monitored to ensure that the proper shifts intheir body orientation take place. Examples of conditions that mayrequire periodic shifting may include mobility-limiting conditions suchas wheel chair confinement, Restless Leg Syndrome, infants that tend toroll over onto their stomach, or patients at risk for pneumonia thatmust sit up periodically. Many patients who suffer from such conditionsare not monitored continuously because they may live at home bythemselves or where family members can not be present at all times or bein a health care facility where attendants are cycled in betweenpatients. As a result, occurrences of life threatening events may gounnoticed until it is too late or shifts in body orientation may bemissed, resulting in skin ulcers, pneumonia, suffocation, or any otherlife-threatening conditions. Currently available patient movementmonitoring systems mainly monitor the location of the patient and do nothave the capability of detecting small movements such as shifts in bodyorientation or seizures. Additionally, currently available patientmovement monitor systems are typically specialized to monitor for one ortwo conditions and are not adaptable to multiple conditions that apatient may have concurrently or to multiple patients with differentconditions.

A particular problem area concerns pressure ulcers. As patients whosuffer from mobility limiting conditions must be monitored and shiftedat certain time intervals to minimize the chance for the occurrence ofskin ulcers, also known as bed sores. If a patient is left in anorientation for a long time period (e.g., for over 2 hours), there is arisk for development of skin ulcers on one or more contact points alongthe body. Currently, nurses in health care facilities where suchpatients are housed visit and “turn” patients at certain time intervals.This method does not, however, take into account movements of thepatient in between nurse visits. A common scenario is as follows. In afirst visit, a nurse may have assisted a patient to shift from the righttowards the left, but in between the first visit and a second visit, thepatient may have shifted back towards the right, only to shift backtowards the left right before the second visit. From the nurse'sperspective, the patient has been on his left for the period between thefirst and second visits and thus concludes that the patient should nowbe shifted towards the right, resulting in the patient spending too muchtime shifted towards the right. In health care facilities, there arecommonly too few nurses to continuously monitor any one patient, thusmaking it nearly impossible to be aware of the shifts that may happen inbetween any two visits from the nurse.

BRIEF SUMMARY

A monitoring system and method tracks a patient's position over time andensures that proper turning is done within the time prescribed.Preferably, the techniques herein continuously monitor patient positionand alert medical or other personnel of the need for turning or otherpatient manipulation. The system may be implemented within a medical orother care facility, or within a patient's home.

In one embodiment, a monitoring system comprises several components: asensor, a monitor, and an output device. The sensor is adapted to becarried by a patient and outputs spatial information associated with thepatient's physical orientation. The monitor is in operativecommunication with the sensor to receive the spatial informationtogether with temporal information. The monitor uses the spatial andtemporal information to determine whether the patient is following apatient turn protocol. If not, a notification is provided by the outputdevice so that remedial action can be initiated.

The foregoing has outlined some of the more pertinent features of theinvention. These features should be construed to be merely illustrative.Many other beneficial results can be attained by applying the disclosedinvention in a different manner or by modifying the invention as will bedescribed.

BRIEF DESCRIPTION OF THE FIGURES

For a more complete understanding of the disclosed invention and theadvantages thereof, reference is now made to the following descriptionstaken in conjunction with the accompanying drawings, in which:

FIG. 1 is a schematic representation of the patient follower in arepresentative embodiment;

FIG. 2 is a schematic representation of the movement detection system ina representative embodiment;

FIG. 3 is a schematic representation of a variation of the patientfollower of a representative embodiment;

FIG. 4-8 are schematic representations of variations of the movementdetection system;

FIG. 9 illustrates a representative use case based on spatial (position)and temporal (time) information in a representative embodiment;

FIG. 10 illustrates a further example of a use case; and

FIG. 11 illustrates a representative system using a handheld device asthe bedside monitor.

DESCRIPTION OF REPRESENTATIVE EMBODIMENTS

The following description of several embodiments is not intended tolimit the invention, but rather to enable any person skilled in the artto make and use this invention.

As shown in FIGS. 1 and 2, an illustrative movement detection system 10includes a patient follower 20 that includes a sensor 22 that detectsmovement, a follower transmitter 24 that transmits a signal 52indicating the occurrence of a movement, and a base 26 that couples thesensor 22 and the follower transmitter 24 to the patient. In oneembodiment, the patient follower is a physically wearable, potentiallydisposable sensor device that monitors the patient's position andtransmits the information to one or more other devices. The signal 52preferably is transmitted to a bedside receiving station 30 and thebedside receiving station 30 then preferably transmits a signal 52′ toan attendant (e.g., nurse) receiving station 40. Alternatively, thefollower transmitter 24 may transmit the signal 52 directly to theattendant receiving station 40. The bedside receiving station 30 and/orthe attendant receiving station 40 preferably functions to interpret thedata from the signal 52 to determine the need for attention.Alternatively, the patient follower 20 may function to interpret datafrom the sensor 22 to determine the need for attention. The method fordetermining the need for attention may be adjusted for any number ofapplications, thus allowing the system to be adapted to a variety ofapplications. The movement detection system 10 also preferably receivesand stores data related to the movements detected. However, any otherarrangement of the movement detection system 10 suitable to monitoring apatient may be used.

As seen in FIG. 4, the movement detection system may also include asignal 52″ that is sent to the patient. The signal preferably providesan indication to the patient, e.g., to shift orientation, which allowsthe patient the knowledge and opportunity to shift himself or herself.

1. Patient Follower

The patient follower 20 functions to follow the user and continuouslymonitor the patient for movements that may need to be addressed by anattendant (e.g., an attendant, a family member, a remote communicationcenter). The patient follower 20 is preferably coupled to the patient'sbody and is preferably wireless (e.g., the device preferably includes aself-contained power source and includes a wireless transmitter) tominimize discomfort to the patient, but may alternatively be wired (foreither power or communications). Any other arrangement of the patientfollower 20 suitable to continuously monitor the patient for movementsmay be used.

The sensor 22 functions to sense movement and orientation of thepatient. The sensor 22 preferably is coupled to the patient through thebase 26 (which, for example, may be a holder affixed to or carried bythe patient) and is preferably capable of determining orientation andchanges in orientation such that, when coupled to the patient, changesin the sensor's readings will directly indicate changes in the patient'sorientation. The sensor 22 is preferably an accelerometer that providesdata for any orientation. The accelerator may be a 3-axis accelerometer,but may alternatively be a 2-axis accelerometer with an orientationindicator to indicate the proper orientation of the sensor 22 relativeto the patient.

The sensor 22 may alternatively be a sensor that is triggered only whenone of plurality of set states is present, each state correlating to aspecific orientation of the patient, for example, the patient lyingdown, sitting, standing, or walking. In this variation of the sensor 22,the sensor 22 selectively reports data regarding the orientation of thepatient, simplifying both the communication and the interpretation ofthe data from the sensor 22. The sensor 22 in this variation may anoptical sensor that monitors fluid within a straight or curved tubewherein the fluid shifts within the tube as the patient shifts, acontact switch that monitors a ball bearing within a straight or curvedtube wherein the ball within the tube shifts as the patient shifts, orany suitable type of tilt sensor or vibration sensor. However, thesensor 22 may be any other sensor suitable to indicate orientationand/or movement.

In an iPhone®-based application such as described below, the sensoritself may be implemented as an application on the device itself, itwhich case the native accelerometer in the device can be used for theabove-described purposes of determining patient orientation.

The follower transmitter 24 functions to transmit a signal 52 from thepatient follower 20 that indicates the patient's orientation and/or theoccurrence of a movement that may require the attention of an attendant.The follower transmitter 24 is preferably a conventional signaltransmitter, but may alternatively be any suitable device that transmitsa signal. The follower transmitter 24 preferably transmits the signal 52through a wireless network such as WiFi, cellular, Bluetooth, ZigBee,Internet Protocol (IP)-based network, or any other suitable network,further allowing the patient follower 20 to be a wireless component.Alternatively, the follower transmitter 24 may transmit the signal 52through Ethernet, cable, or any other suitable wired network.

The sensor 22 and the follower transmitter 24 are preferably incommunication with each other. The follower transmitter 24 preferablyremains in a stand-by mode until data is received from the sensor 22,but may alternatively actively retrieve data from the sensor 22 to betransmitted through the signal 52. In both variations, the followertransmitter 24 preferably receives data from the sensor 22 and transmitsthe signal 52 at regular intervals, but the follower transmitter 24 mayalternatively continuously receive data from the sensor 22 whiletransmitting the signal 52 at regular intervals. Alternatively, thefollower transmitter 24 may receive data from the sensor 22 only when amovement that may require attention is detected. However, any othersuitable timing or arrangement of receiving and sending data between thesensor 22, the follower transmitter 24, and the signal 52 may be used.

The base 26 functions to couple the sensor 22 and the followertransmitter 24 to the patient. The base 26 preferably includes at leastone portion of a type of adhesive that may be coupled to the patient'sskin for a period of time and removed when finished. The base 26 mayalso include a second portion of a second type of adhesive appropriateto couple the sensor 22 and the follower transmitter 24 to the base 26.The sensor 22 and the follower transmitter 24 is preferably pre-coupledto the base 26 to facilitate coupling of the patient follower 10 to thepatient, but may alternatively be surgical tape, medical tape, or anyother suitable adhesive to secure the sensor 22 and the follower 24 tothe patient. The base 26 is preferably disposable, but may alternativelybe reusable. The base 26 may also include rigid portions to protect thesensor 22 and the follower transmitter 24. The rigid portions may beseparately molded to contain the sensor 22 and the follower transmitter24 and then coupled to the base 26. The base 26 may also includechannels for data transfer and/or power transfer, for example, a printedcircuit. The base 26 is preferably of a material that is water andsweat-resistant to both protect the sensor 22 and the followertransmitter 24 and to remain robust under conditions commonly seen bythe patient. However, any other suitable material and arrangement of thebase 26 may be used.

The patient follower 20 may also includes a power source 28, as shown inFIG. 3. The power source 28 is preferably coupled to the sensor 22and/or the follower transmitter 26, but may alternatively be coupled tothe base 26. The power source 28 is preferably one of severalvariations. In a first variation, the power source 28 is a battery. Thebattery is preferably a small, flat battery such as a coin (or button)cell (e.g., lithium-based) battery, but may alternatively be anysuitable battery. In a second variation, the power source 28 ispreferably a power cord that attaches to the power grid. Although thepower source 28 is preferably one of these two variations, the powersource 28 may be any suitable device to supply power to the elementscoupled to the patient follower 20. In an RFID variation, the device maybe powered by a transmitter signal received at the device.

The patient follower 20 may further include a follower storage device29, as shown in FIG. 3, coupled to the sensor 22 and/or the followertransmitter 24. The follower storage device 29 of an illustrativeembodiment functions to store information related to the patientfollower 20 and/or any movement detected by the sensor 22. The followerstorage device 29 is preferably a conventional memory chip, such as RAM,a hard drive, or a flash drive, but may alternatively be any suitabledevice able to store information. The information that the followerstorage device 29 may store includes the patient's orientation, theduration of the patient's current orientation, the current time, anindication of a necessary change in orientation, the patient's change inorientation, the magnitude of the change in orientation, the frequencythe number of orientation changes that have occurred, the frequency oforientation changes, the date and time of any given orientation change,the date and time of an attendant's response to any given orientationchange, the average response time of an attendant, the patientidentification number, the patient's personal information, the patient'shealth information, the patient's attendant's and/or attendant'sinformation, and/or any other suitable information.

2. The Signal

The signal 52 is transmitted (preferably over the air) by the followertransmitter 24 and includes data representative of the orientationand/or movement of the patient. The signal 52 may include any or all ofthe following information: the patient's orientation, the duration ofthe patient's current orientation, the current time, an indication of anecessary change in orientation, the patient's change in orientation,the magnitude of the change in orientation, the number of orientationchanges that have occurred, the frequency of orientation changes, thedate and time of any given orientation change, the date and time of anattendant's response to any given orientation change, the averageresponse time of an attendant, the patient identification number, thepatient's personal information, the patient's health information, thepatient's attendant's and/or attendant's information, and/or any othersuitable information. The signal 52 is preferably one of severalvariations.

In a first variation, the signal 52 is transmitted by the followertransmitter 24 to the bedside receiving station 30 and/or the attendantreceiving station 40, as shown in FIG. 2, to be interpreted. The bedsidereceiving station 30 and/or the attendant receiving station 40 then usesthe data within the signal 52 to determine the need for attention (e.g.,the need for a nurse to turn the patient and, if a need is determined,to warn the attendant of the patient's need for attention, to indicatethe turn of the patient, and/or to indicate the position that would bemost appropriate for the patient at the current time.

In a second variation, the signal 52 is transmitted to the bedsidereceiving station 30 and/or the attendant receiving station 40 when thepatient follower 20 detects a need for attention. In this variation, thebedside receiving station 30 and/or the attendant receiving station 40functions to warn the attendants of the patient's need for attentione.g., the need for a nurse to turn the patient and, if a need isdetermined, to warn the attendant of the patient's need for attention,to indicate the turn of the patient, and/or to indicate the positionthat would be most appropriate for the patient at the current time.

In a third variation, the patient follower 20 functions to transmit thesignal 52 at regular intervals to the bedside receiving station 30and/or the attendant receiving station 40. In this variation, thebedside receiving station 30 and/or the attendant receiving station 40function to display the data from the signal 52 for an attendant tointerpret. The receiving stations 30 and/or 40 preferably also functionto interpret the signal 52 to display indications or warnings to furtherengage the attendant's attention when the patient needs attention (e.g.,when the patient needs to be turned to a different position).

In a fourth variation, the patient follower 20 functions as a firstlevel warning or indication of a potential patient need for attentionthat is further verified by the bedside receiving station 30 and/or theattendant receiving station 40. In this variation, the patient follower20 functions to transmit the signal 52 when a movement of a certaindegree is detected. Upon receiving the signal 52, the receiving stations30 and/or 40 interpret the movement relative to previously storedmovements to determine whether there is a real need for attention. Forexample, a patient on a wheel chair may have been shifted to the leftfor a duration of time, and slightly before the patient is due to beshifted to the right by an attendant, the patient shifts to the rightwithout assistance. The patient follower 20 will send a signalindicating the shift and the potential need for attention, but thereceiving stations 30 and/or 40 may evaluate this with the historicaldata to determine that there is no need for attention because theattendant is scheduled to shift the patient towards the right in arelatively short time and will instead indicate that the routineshifting of the patient has already been carried out, saving theattendant an extra visit.

In any of the above variations, upon detection of the need for attendantattention, a signal 52″ may be transmitted from the patient follower 20,bedside receiving station 30, and/or attendant receiving station 40 tothe patient, as shown in FIG. 4. The signal 52″ preferably provides asignaling sensation to the patient and indicates the need for a routineshift in orientation, a warning for having walked too far/ and/or fast,a warning for a non-recommended activity, and/or a warning for any othersuitable event. This provides the patient with the knowledge and theopportunity to correct and/or adjust him or herself without theattendant's assistance. By allowing the patient this knowledge andopportunity, a patient that has enough mobility to correct and/or adjustis encouraged to do so, saving the attendant from an unnecessary tripand allowing the attendant to tend other patients with greater need. Inthis version, the movement detection system 10 preferably functions tomonitor the time from when the patient was first notified of the needcorrect/and or adjust and when the patient carries out the correctionand/or adjustment. This data may be useful in determining thewillingness of the patient to comply with the notification system. Themovement detection system 10 may also detect if the patient has notcarried out the correction and/or adjustment after a certain period oftime after the notification was sent and preferably sends a warning tothe attendant if the patient has not shifted orientation within theperiod of time. This may indicate the need for attendant attention.Alternatively, if the patient has not corrected and/or adjusted withinthe period of time, the signal 52″ may be resent for a certain number oftimes before an attendant is notified. The signal 52″ is preferably anaudible signal such as a beep, an alarm, or a voice. The signal 52″ mayalternatively be a visual sensation, a tactile sensation and/or anyother suitable notification.

Although the signal 52 is preferably at least one of the abovevariations, the signal 52 may be any suitable signal, including anysuitable information, and in any suitable arrangement to represent dataon the orientation and/or of the patient. The signal 52 may also be anysuitable combination of the above variations.

3. Bedside Receiving Station

The bedside receiving station 30 functions to receive the signal 52 fromthe follower transmitter 24 and to receive a signal from the attendantreceiving station 40. Additionally, the bedside receiving station 30 mayfunction to receive signals from multiple follower transmitters 24, asthere may be multiple regions on the patient wherein movement ismonitored, or multiple patients with patient followers 20 in the room,as shown in FIG. 7.

The bedside receiving station preferably includes a bedside receiver 32.The bedside receiver 32 is preferably a conventional signal receiver,but may alternatively be any suitable device to receive a signal. Thebedside receiving station 30 is preferably one of several variations.

In a first variation, as shown in FIG. 2, the bedside receiving station30 is a physical station. The bedside receiving station 30 is preferablylocated in the patient's room and near the patient's beside. The bedsidereceiving station 30 may be located near the bedside or coupled to thebed frame. The bedside receiving station 30 may alternatively be locatedin any suitable location, such as coupled to a patient's stretcher orwheel chair that moves with the patient, such that it can receive thesignal 52 from the follower transmitter 24 and receive a signal from theattendant receiving station 40.

In a second variation, as shown in FIG. 5, the bedside receiving station30′ is a mobile device. The mobile device is preferably a pager to beworn by the attendant or attendant, but may alternatively be a cellphone, a PDA, a smart phone, a laptop computer, or any combinationthereof.

In a third variation, the bedside receiving station 30 is coupleddirectly to the patient follower 20. Although the bedside receivingstation 30 is preferably at least one of these three variations, thebedside receiving station 30 may be any suitable device to receive thesignal 52 from the follower transmitter 24 and receive a signal from theattendant receiving station 40.

The bedside receiving station 30 may further include a bedside displaydevice 34, as shown in FIG. 2, which functions to display informationrelevant to the patient follower 20, the patient, and/or the movementdetected by the patient follower 20. The bedside display device 34 ispreferably a conventional screen such as an LCD screen, a computermonitor, or a television screen. The bedside display device 34 couldalternatively be any suitable display device such as Internet webpage.Additionally, the bedside display device 34 may include speakers oralarms such that information may be displayed in an audible fashion aswell. The information displayed by the bedside display device 34 mayinclude any or all of the following information: the patient'sorientation, the correct orientation for the patient, the duration ofthe patient's current orientation, the current time, an indication of anecessary change in orientation, the patient's change in orientation,the magnitude of the change in orientation, the number of orientationchanges that have occurred, the frequency of orientation changes, thedate and time of any given orientation change, the date and time of anattendant's response to any given orientation change, the averageresponse time of an attendant, the patient identification number, thepatient's personal information, the patient's health information, thepatient's attendant's and/or attendant's information, and/or any othersuitable information.

The bedside receiving station 30 may further include a bedside userinterface 36, as shown in FIG. 2, which functions to accept an inputfrom a user, such as an attendant or attendant. The bedside userinterface 36 is preferably a conventional user interface includingbuttons, dials, a keyboard, a touch screen, a mouse, a switch, amicrophone, and/or any other suitable user interaction device. Theinformation entered by an attendant or attendant into the bedside userinterface 36 may include any or all of the following information: thepatient's orientation, the correct orientation for the patient, aconfirmation for the detected orientation and the actual orientation ofthe patient, the duration of the patient's current orientation, thecurrent time, an indication of a necessary change in orientation, thepatient's change in orientation, the magnitude of the change inorientation, the number of orientation changes that have occurred, thefrequency of orientation changes, the date and time of any givenorientation change, the date and time of an attendant's response to anygiven orientation change, the average response time of an attendant, thepatient identification number, the patient's personal information, thepatient's health information, the patient's attendant's and/orattendant's information, and/or any other suitable information. Whilethe bedside receiving station preferably includes a user interface withan input, other versions of the motion detection system may omit thisfeature and/or step.

The bedside receiving station 30 may further include a bedsidetransmitter 33, as shown in FIG. 2. The bedside transmitter 33 of thepreferred embodiments functions to transmit a signal 52′ indicating theoccurrence of a movement. The bedside transmitter 33 is preferably aconventional signal transmitter, but may alternatively be any suitabledevice that transmits a signal. The bedside transmitter 33 preferablytransmits the signal 52′ through a wireless network such as WiFi,cellular, Bluetooth, ZigBee, IP-based network, or any other suitablenetwork. Alternatively, the bedside transmitter 33 may transmit thesignal 52′ through Ethernet, cable, or any other suitable wired network.

The signal 52′ preferably is the same as the signal 52 of the preferredembodiments, but may alternatively be altered by the bedside receiver30. The bedside receiver 30 may serve as a filter or an interpreter ofthe signal 52 from the patient follower 20 and only send the signal 52′when attention is required. The signal 52′ is preferably transmitted bythe bedside transmitter 33.

The bedside receiving station 30 may further include a bedside processor38 and a bedside storage device 39 coupled to the bedside processor 38,as shown in FIG. 2. The bedside processor 38 is coupled to the bedsidereceiver 32, the bedside display device 34, the bedside user interface36, and the bedside transmitter 33. The bedside processor 38 functionsto process the information received by the bedside receiver 32 and thebedside user interface 36 and to transmit the relevant information tothe bedside display device 34, the bedside transmitter 33, and thebedside storage device 39. The bedside processor 38 is preferably aconventional processor, but may alternatively be any suitable device toperform the desired functions. The bedside storage device 39 of thepreferred embodiments functions to store information transmitted by thebedside processor 38, related to the patient follower 20, movementsdetected by the patient follower 20, and/or the attendant's response toa movement. The bedside storage device 39 is preferably a conventionalmemory chip, such as RAM, a hard drive, or a flash drive, but mayalternatively be any suitable device able to store information.

4. Attendant Receiving Station

The attendant (or “nurse”) receiving station 40 of the preferredembodiments functions to receive the signal 52′ from the bedsidetransmitter 33 and may also receive a signal 52 from the followertransmitter 24. Additionally, the attendant receiving station 40 mayfunction to receive signals from multiple bedside transmitters 33, asthere may be multiple bedside transmitters 33 in a room or building, asshown in FIG. 7. The attendant receiving station preferably includes anattendant station receiver 42. The attendant station receiver 42 ispreferably a conventional signal receiver, but may alternatively be anysuitable device to receive a signal. The attendant receiving station 40is preferably one of several variations.

In a first variation, as shown in FIG. 2, the attendant receivingstation 40 is a physical station. The attendant receiving station 40 ispreferably located at the nursing or attendant's station or in thehallway. The attendant receiving station 40 may alternatively be locatedin any suitable location, such as coupled to a patient's stretcher orwheel chair that moves with the patient, such that it can receive thesignal 52′ from bedside transmitter 33 and may also receive a signal 52from the follower transmitter 24. The attendant receiving station 40 mayalso be in a remote location such as a control center.

In a second variation, as shown in FIG. 6, the attendant receivingstation 40′ is a mobile device. The mobile device is preferably a pagerto be worn by the attendant or attendant, but may alternatively be acell phone, a PDA, a smart phone, a laptop computer, or any combinationthereof.

In a third variation, the attendant receiving station 40 may be aphysical station that includes a mobile device or a series of mobiledevices, as described above, that may be worn or held by an attendant orattendant.

In a fourth variation, the attendant receiving station may be aconventional attendant station. In this variation, the movementdetection system 10, including the bedside receiving station 30, wouldinterface with the conventional attendant station. The movementdetection system 10 would interface with the nursing station through anapplication programming interface (API) and/or a wireless network suchas WiFi, cellular, Bluetooth, ZigBee, Internet-protocol based network,or any other suitable network. Alternatively, the movement detectionsystem 10 would interface with the nursing station through Ethernet,cable, any other suitable wired network, or any combination thereof.Although the attendant receiving station 40 is preferably at least oneof these variations, the attendant receiving station 40 may be anysuitable device to receive the signal 52′ from the bedside transmitter33 and may also receive a signal 52 from the follower transmitter 24.

The attendant receiving station 40 may further include an attendantstation display device 44, as shown in FIG. 2, which functions todisplay information relevant to the bedside receiving station 30, thepatient follower 20, the patient, and/or movement detected by thepatient follower 20. The attendant station display device 44 ispreferably a conventional screen such as an LCD screen, a computermonitor, or a television screen. The attendant station display device 44could alternatively be any suitable display device such as Internetwebpage. Additionally, the attendant station display device 44 mayinclude speakers or alarms such that information may be displayed in anaudible fashion as well. The information displayed by the attendantstation display device 44 may include any or all of the followinginformation: the patient's orientation, the correct orientation for thepatient, the duration of the patient's current orientation, the currenttime, an indication of a necessary change in orientation, the patient'schange in orientation, the magnitude of the change in orientation, thenumber of orientation changes that have occurred, the frequency oforientation changes, the date and time of any given orientation change,the date and time of an attendant's response to any given orientationchange, the average response time of an attendant, the patientidentification number, the patient's personal information, the patient'shealth information, the patient's attendant's and/or attendant'sinformation, and/or any other suitable information.

The attendant receiving station 40 may further include an attendantstation user interface 46, as shown in FIG. 2, which functions to acceptan input from a user, such as an attendant or attendant. The attendantstation user interface 46 is preferably a conventional user interfaceincluding buttons, dials, a keyboard, a touch screen, a mouse, a switch,a microphone, and/or any other suitable user interaction device. Theinformation entered by an attendant or attendant into the attendantstation user interface 46 may include any or all of the followinginformation: the patient's orientation, the correct orientation for thepatient, confirmation for the detected orientation and the actualorientation of the patient, the duration of the patient's currentorientation, the current time, an indication of a necessary change inorientation, the patient's change in orientation, the magnitude of thechange in orientation, the number of orientation changes that haveoccurred, the frequency of orientation changes, the date and time of anygiven orientation change, the date and time of an attendant's responseto any given orientation change, the average response time of anattendant, the patient identification number, the patient's personalinformation, the patient's health information, the patient's attendant'sand/or attendant's information, and/or any other suitable information.

The attendant receiving station 40 may further include an attendantstation transmitter 43, as shown in FIG. 2. The attendant stationtransmitter 43 of the preferred embodiments functions to transmit asignal 52′″ indicating an attendant's response to a movement and/orindicating the occurrence of a movement. The attendant stationtransmitter 43 is preferably a conventional signal transmitter, but mayalternatively be any suitable device that transmits a signal. Theattendant station transmitter 43 preferably transmits the signal througha wireless network such as WiFi, cellular, Bluetooth, ZigBee, IP-basednetwork, or any other suitable network. Alternatively, the attendantstation transmitter 43 may transmit the signal through Ethernet, cable,or any other suitable wired network.

The signal 52′″ is transmitted by the attendant station transmitter 43and indicates an attendant's response to a movement and/or an occurrenceof a movement. In the third variation of the attendant receiving station40, wherein the attendant receiving station is a physical station thatincludes a mobile device or a series of mobile devices that may be wornor held by an attendant or attendant, the signal 52′″ may be sent fromthe physical station to the mobile device or to the bedside receivingstation 30 as shown in FIG. 8. The signal 52′″ is preferably one ofseveral variations. In a first variation, the signal indicates anattendant's response to a movement and is transmitted by the attendantstation transmitter 43 to the bedside receiving station 30. The signalmay include any or all of the following information: the patient'sorientation, the duration of the patient's current orientation, thecurrent time, an indication of a necessary change in orientation, thepatient's change in orientation, the magnitude of the change inorientation, the number of orientation changes that have occurred, thefrequency of orientation changes, the date and time of any givenorientation change, the date and time of an attendant's response to anygiven orientation change, the average response time of an attendant, thepatient identification number, the patient's personal information, thepatient's health information, the patient's attendant's and/orattendant's information, and/or any other suitable information. In asecond variation, the signal indicates the need for attention and istransmitted by the attendant station transmitter 43 to the attendant.The signal 52′″ in this variation provides a signaling sensation to theattendant. The signal is preferably an audible signal such as a beep, analarm, or a voice. The signal may alternatively be a visual sensationand/or a tactile sensation. Although the signal is preferably at leastone of these two variations, the signal may be any suitable signal,including any suitable information, to indicate the occurrence of amovement and/or an attendant's response to a movement.

The attendant receiving station 40 may further include an attendantstation processor 48 and an attendant station storage device 49 coupledto the attendant station processor 48, as shown in FIG. 2. The attendantstation processor 48 is coupled to the attendant station receiver 42,the attendant station display device 44, the attendant station userinterface 46, and the attendant station transmitter 43. The attendantstation processor 48 functions to process the information received bythe attendant station receiver 42 and the attendant station userinterface 46 and to transmit the relevant information to the attendantstation display device 44, the attendant station transmitter 43, and theattendant station storage device 49. Additionally, the attendant stationprocessor 48 may prioritize the information received by the attendantstation receiver 42 and the attendant station user interface 46 (e.g.,based on the patient information associated with the given movement) andtransmit the prioritized relevant information to the attendant stationdisplay device 44, the attendant station transmitter 43, and theattendant station storage device 49. The attendant station processor 48is preferably a conventional processor, but may alternatively be anysuitable device to perform the desired functions. The attendant stationstorage device 49 of the preferred embodiments functions to storeinformation transmitted by the attendant station processor 48, relatedto the patient follower 20, the movement detected by the patientfollower 20, and/or the attendant's response to a movement. Theattendant station storage device 49 is preferably a conventional memorychip, such as RAM, a hard drive, or a flash drive, but may alternativelybe any suitable device able to store information.

Alternatively, the attendant receiving station 40 may include anindicator and an attendant station receiver 42, wherein the attendantstation receiver 42 functions to receive signal 52 from the patientfollower 20 and/or the signal 52’ from the bedside receiving station 30,and wherein the indicator is preferably located on the door of thepatient's room, but may alternatively be located by the patient's bed,and/or on an indicator panel that is visible to an attendant. Theindicator of this variation of the attendant receiving station 40 ispreferably a light (e.g. an LED), but may alternatively be an audiblealert, a flag, or any other suitable indicator that is visible to theattendant. This variation of the attendant receiving station 40 allowsfor a relatively inexpensive and simple implementation of the movementdetection system 10 in health care facilities and/or a home.Additionally, because of the lower power usage of this variation of theattendant receiving station 40, the attendant receiving station 40 maybe powered using a solar cell that collects power from hallway lights orany other available light source, but may alternatively be powered by abattery. An attendant receiving station 40 of this variation that ismounted to a door may also be powered using the rotational motion of thedoor as it is opened or closed and/or the rotational motion of a doorknob/handle. However, any other suitable power source may be used. In anexemplar usage scenario, an indicator light that is visible to theattendant lights up whenever the movement detection system 10 indicatesthe need for attendant attention. The indicator light is preferablyassigned to a particular patient, allowing the attendant to go to thepatient. The attendant may then receive data regarding the actionrequired for the patient from the bedside receiving station 30, a paperchart, and/or any other data containing medium, and determine thecorrect action to be taken with the patient. The indicator light may belocated on the door of the patient's room that is visible to anattendant as the attendant walks by, either as the attendant is makingrounds checking on patients or passing by on the way to another task.The indicator light may also be located on an indicator panel by anattendant's station, wherein the indicator panel may include a pluralityof indicator lights, each pertaining to a particular patient.

Although the attendant receiving station 40 preferably includes thecomponents described above and is preferably of one of the variationsdescribed above, the attendant receiving station 40 may alternatively beof any other suitable arrangement or type.

5. Method to Determine the Need for Attendant Attention

The movement detection system 10 is preferably applicable to a pluralityof applications. The method for determining whether the attention of anattendant is necessary is different for each application. However, eachmethod includes the steps of (a) either detecting a shift in theorientation of the patient or detecting the actual orientation of thepatent, (b) determining the appropriate orientation of the patient, and(c) sensing elapsed time. The method to evaluate the detectedinformation is preferably one of several variations for a variety ofapplications.

In a first variation, the movement detection system 10 is preferablyused for monitoring required shifts in the patient's orientation tominimize the risk of skin ulcers. In this variation, the patientfollower 20 is placed on different portions of the patient's bodydepending on the type of shift that the movement detection system 10 isdetecting. For example, in the case of minimizing the risk of skinulcers and preventing pneumonia, a patient must be placed in a sittingposition periodically after laying down for period of time. In thiscase, a patient follower 20 may be placed on the patient's torso.Alternatively, two patient followers 20 may be used, a first placed onthe patient's torso and a second placed on the patient's hip whererelative data between the first and second patient followers 20 isanalyzed to determine whether the patient is sitting or lying down. In asecond example, in the case where a patient is confined to a wheelchair,the risk of skin ulcers is minimized by periodic shifts in the patient'sweight within the wheelchair. In this case, a patient follower 20 may beplaced on the patient's hip to detect whether the patient's position haschanged within a period of time, indicating a shift in weight. In athird example, the patient may be an infant wherein a resting positionon the infant's stomach is undesired. In this case, the patient follower20 may be placed anywhere along the infant's abdomen, chest, and/or backarea to detect if the infant has shifted onto its stomach. In a fourthexample, the patient may be suffering from RLS (Restless Leg Syndrome)wherein the leg is preferably shifted after certain periods of time.

In this first variation, the maximum period of time that the patient maybe in a certain orientation may be manually inputted into the movementdetection system 10 by an attendant. The system 10 then preferablyutilizes the maximum time inputted by the attendant as a time-onthreshold and detects the time the patient has been in any one positionand compares the time detected to the time-on threshold. If the timedetected is greater than the time-on threshold, then warning is sent tothe attendant and/or the patient to notify the need for a shift inorientation. The attendant may alternatively input a minimum period oftime that the patient should be in a first orientation, wherein thesystem 10 utilizes the minimum period of time as a minimum time-onthreshold. The system 10 detects the time the patient has been in thefirst orientation and compares the time detected to the minimum time-onthreshold and when the patient shifts to a second orientation when thetime detected is less than the minimum time-on threshold, then a warningis sent to the attendant and/or the patient to notify the need to returnto the first orientation.

In a second variation, the movement detection system 10 is preferablyused for the detection of occurrences of sudden convulsive attacks withrelatively high frequency such as asthma, seizures, heart attacks,and/or excessive sneezing. In this variation, the patient follower 20may be placed along the torso area of the chest or any other location onthe body of the patient wherein the convulsions are most prominent. Forexample, in the case of an asthma attack, there may be a higher degreeof movement in the torso region of the patient, whereas in the case ofseizures, there may be a higher degree of movement by the head area ofthe patient. In this variation, the movement detection system 10 looksfor a frequency of movement that matches a frequency seen in the type ofattack that the system 10 is monitoring for. This frequency for eachtype of convulsion may be preprogrammed into the movement detectionsystem 10 and then selected by an attendant based upon convulsion type.The frequency may also be inputted directly into the system by theattendant based upon the unique characteristics of each patient, forexample, some patients may be prone to lower frequency convulsions whileothers may be prone to higher frequency convulsions. The frequency mayalso be a variable frequency to match the type of condition that isbeing monitored. For example, some conditions may result in an erraticfrequency, while others may be defined by a series of frequencies or anincrease and/or decrease of frequency. However, any suitable series orset of frequencies may be used.

In a third variation, the movement detection system 10 is preferablyused for the detection of walking, excessive motion, moving onto oneside (such as moving onto a side with an injury or moving onto theirstomach position and possibly involving a Sudden Infant Death Syndromesituation), lack of minute (such as lack of breathing), or moving awayfrom a lying down position when the patient should be confined to thebed. In this variation, the patient follower 20 may be coupled to anyportion of the patient's body that best indicates the motion that isbeing monitored. For example, if walking activities are to be monitored,the patient follower 20 may be coupled to the patient's leg and if theaction of getting up from a bed is to be monitored, then the patientfollower 20 may be coupled to the patient's chest. In this variation,the degree of movement may be used to trigger the occurrence of anundesirable event (e.g., getting up from the bed, or falling down). Apattern may also be detected for the motion of walking and the number ofsteps taken by the patient may be detected to determine if there isexcessive movement or the patient has moved too far. The pace of walkingmay also be monitored to determine of the patient is walking too fast,which may result in strenuous activity. Similar to other variations, thethresholds for each of the conditions may be inputted by an attendant toaccommodate to each unique patient.

Although the method for determining the need for attendant attention ispreferably at least one of the above variations, the method may be ofany suitable type or sequence. The method for determining the need forattendant attention may also be any suitable combination of the abovevariations. Several methods may also be used concurrently to accommodateto patients with multiple needs.

When the system is used to prevent pressure ulcers, the method furtherincludes interpreting whether data from the sensor indicates a shift inorientation of the patient. The step of determining the appropriateorientation of the patient preferably is one of several variations.

In a first variation, the step of determining the appropriateorientation of the patient uses a proportional relationship between atime-on value and a time-off value. The time-on value is a measuredvalue indicating the time the patient has been in a first orientationand the time-off value is a resultant value that is calculated basedupon the time-on value, wherein the time-off value indicates the minimumlength of time the patient should be shifted away from the firstorientation after the patient has been in the first orientation for thetime-on value to lower the risk of a skin ulcer.

The step of determining the appropriate orientation of the patient mayfurther use a constant (user-selected, system-selected, or the like)that is an indicator of health, hereafter known as the health indicatorconstant. The health indicator constant is preferably a value that isderived from the patient's age, circulatory health, medication,diseases, and any other ailments that the patient may have. The healthindicator constant may alternatively include any other factors that maycontribute to the patient's overall health. For example, the healthindicator constant for a patient with poor circulatory health may behigher than the health indicator constant for a patient with relativelybetter circulatory health, resulting in a longer time-off value for thepatient with poor circulatory health relative to the time-off value forthe patient with relatively better circulatory health, allowing damagedskin of the patient with poor circulatory health to have more time torecover from extended pressure applied from the patient's orientation.This proportional relationship between the time-off value and thetime-on value with a health indicator constant allows for the movementdetection system 10 to more effectively accommodate to individualpatients and to more efficiently use the precious time of the nurses.The health indicator constant is preferably calculated based upon thepatient's statistics, but may alternatively be manually entered by amedical practitioner. Manual input from a medical practitioner allowsthe system to further accommodate to the unique statistics of eachpatient by utilizing the opinion of a medical practitioner directlyfamiliar with the patient. The manual input for the health indicatorconstant may be from a scale indicating relative health of the patient,for example, a scale from 1 to 5 with 5 being very healthy and 1 beingnot healthy, but may alternatively be a matrix of information that isentered by the medical practitioner, wherein the information is to beinterpreted by the motion detection system 10 to determine theappropriate health indicator constant. In this variation, the determinedappropriate health indicator constant is preferably adjustable by themedical practitioner to further accommodate to the patient's individualneeds. While the manual input for the health indicator may be optimal,the motion detection system 10 of other variations may omit thisparticular feature and/or step.

In an exemplary use of the first variation, the motion detection system10 preferably detects the time the patient is in a first orientation todetermine a time-on value while determining the respective time-offvalue for the first orientation. If the patient is shifted to a secondorientation, either by a nurse or by him or herself, the time thepatient is in the second orientation is detected and compared to thecalculated time-off value. If the patient is shifted back towards thefirst orientation at a time less than the calculated time-off value,then a warning or indication is issued to the nurse that attention isnecessary. The motion detection system 10 also preferably detects when apatient has been in the first orientation for too long, for example, forover 2 hours, and issues a warning to the nurse that attention isnecessary.

In a second variation, the step of determining the appropriateorientation of the patient uses a time-on threshold and a time-offthreshold to be compared to a time-on value and a time-off value. Thetime-on value is a measured value indicating the length of time thepatient has been in a first orientation and the time-off value is ameasured value indicating the length of time the patient is not in afirst orientation. The time-on threshold indicates the maximum time thepatient is safely in a first orientation and the time-off thresholdindicates the minimum time the patient should be in an orientation otherthan the first orientation before safely resuming the first orientation.The motion detection system 10 preferably compares the time-on value tothe time-on threshold until an event such as the time-on value beingabove the time-on threshold or a shift to a second orientation of thepatient is detected. When a shift in the patient is detected prior tothe time-on value being above the time-on threshold, the motiondetection system 10 preferably starts detecting the time-on value forthe second orientation and compares it to the time-on threshold for thesecond orientation. The same time-on threshold may be used for eachorientation for the patient, but may alternatively be adjusted toaccommodate to different qualities of orientations for each patient. Ina first example, the patient may have been in the second orientation fora second orientation time-on value prior to shifting to the firstorientation. The patient then shifts back to the second orientationprior to the time-off value for the second orientation being greaterthan the time-off value for the second orientation. As a result, themotion detection system 10 will adjust the time-on threshold for thesecond orientation to be a shorter time period to prevent the patientfrom being in the second orientation for too long. In a second example,the patient may have certain orientations that are at higher risk forskin ulcers than others. For example, the patient's right side may havea higher risk for skin ulcers and thus the time-on threshold for theright side may be lower than other orientations and the time-offthreshold for the right side may be higher than other orientations.

In a third variation, the step of determining the appropriateorientation of the patient uses input from the nurse as to what thecorrect orientation for the patient is for a period of time. Anyshifting of orientation from the indicated correct orientation before atime-on threshold is passed may be flagged as a warning to the nurse forattention, wherein the time-on threshold corresponds to the period oftime entered by the nurse. For example, the nurse inputs into the motiondetection system 10 that the patient should be on his or her left sidefor a time-on of at least one hour. If the patient is detected as havingshifted from his or her left side in less than one hour, the nurse iscalled to shift the patient back onto his or her left side.

In a fourth variation, the step of determining the appropriateorientation of the patient uses an input from the nurse as to a firstorientation that the patient should not be in for a period of time. Anyshifting of orientation of the patient into the first orientation beforea time-off threshold is passed may be flagged as a warning to the nursefor attention, wherein the time-off threshold corresponds to the periodof time entered by the nurse. For example, the nurse inputs into themotion detection system 10 that the patient should not be on his or herleft side for a time-off of at least one hour. If the patient isdetected as having shifted onto his left side in less than one hour, thenurse is called to shift the patient off of his or her left side.

Although the method for determining the need for nurse attention ispreferably at least one of the above variations, the method may be ofany suitable type or sequence. The method for determining the need fornurse attention may also be any suitable combination of the abovevariations.

One skilled in the art will appreciate that the determination of whetherto indicate an alert may depend on various programmable factors. Arepresentative, but non-limiting, workflow for an alert might be asshown in FIG. 9, although many suitable variations may be implemented byprogramming or configuring different variables. FIG. 10 illustrates arepresentative process flow for the system operation in the patient turnmonitoring and alert embodiment. The protocol for a representative “use”case might then proceed as follows.

Confirm that the bedside computer is plugged into power and network andturned on. A standard template of hospital personnel authorized toaccess the orders/protocol fields is displayed—the charge nurseindicates the name/position/title of authorized personnel. The templatewill display who can authorize and execute repositioning. Nurse ID badgebarcode is scanned to identify the individual nurse and to allowentering of data into the bedside unit. Patient wristband ID barcode isscanned in order to identify the patient. Information can also beentered manually. Sensor barcode is scanned to identify the individualunique sensor. Room and bed number is entered into the bedside unitusing touch screen. Repositioning protocol is entered into the bedsideunit using the touch screen. Sensor is turned on, initialized and placedon the patient. Baseline position of sensor is established according tocare needs. Confirmation of link is displayed on the touch screen. Thenurse presses end of event command.

When nursing station alarm is activated and repositioning instructionsare given, nurse goes to patient room and bedside. The nurse arrives andscans her badge barcode; preferably, this is required in order to makechanges, as preferably the patient or other occupants of the room areprevented from making changes. Touch screen displays or voice instructscurrent repositioning order. The nurse then turns the patient. After aspecified period of time the bedside unit confirms the turn. The nursepresses the end of event command.

The following describes further information regarding a referenceimplementation for the patient monitoring system for use with patientsto avoid pressure ulcers. In this embodiment, a physically wearable,disposable sensor monitors the patient's position and transmits thisinformation, e.g., by means of a radio signal, to a programmable bedsidecomputer/receiver. The sensor is comfortable to wear, easy to apply andremove, rugged enough to remain in place and fully functional aftershowers, rolling over, etc., preferably activated by a power switch thatremains water tight, and wherein an ON condition is indicated by an LEDthat is easily visible. The sensor continuously sends patient positionto the bedside computer. Preferably, the bedside computer includes aneasily viewable keyboard. In one embodiment, input of the initialpatient position is provided to the bedside computer. The system readsand stores identity of the patient and perhaps the nurse on duty, e.g.,by means of a bar code reader. The system also stores positions which,for a particular patient, are not acceptable. The system alerts thepatient and/or medical personnel of the need to turn the patient (e.g.,in 90° increments) every few hours, or other preset interval, in orderto prevent pressure ulcers. In a preferred embodiment, the bedsidecomputer maintains a continuous log of patient position and turningtimes and displays current position, time since last turn, time untilnext turn, direction and disallowed position(s) as well as patient andnurse identification. The bedside computer sounds an alert when the timeto turn has been reached. A need-to-turn alert sequence preferably iscapable of waking sleeping patients and/or alerting the nursing team. Itmay comprise a flashing light, a flashing computer screen, a low levelaudible alert, progressively louder audible alarms, and automatictelephone call to nursing station or nurse's pager. Preferably, thesystem sounds a different alarm if the patient is turned, or turnshimself/herself, to a disallowed position. Visitors or other personnelin the room may turn the patient (depending on the nature and severityof the illness) thus relieving the nursing staff of the need to do so ateach interval.

In this above-described reference implementation, the sensor may bebased on a wireless sensor device, such as the Freescale ZSTAR sensor(e.g., Model No. RD3152MMA7260Q), and the bedside computer may be aknown device, such as an iPhone® or Android™ device, an iPad™, or anyother mobile, tablet, laptop or the like, that includes an application,utility or other software to implement the above-described functionalityand interfaces. In a preferred implementation, one or more of theabove-described components of the system may be implemented as iPhone orother the like applications. A suitable receiver device at the nurse'sstation may be a USB compatible receiver, such as the Freescale ZSTARMC13191, together with a programmed computer. FIG. 11 illustrates apossible reference.

The above-described techniques may be implemented outside of a medicalor nursing facility, such as in a patient's (or, more generally, auser's) home. As noted above, the receiver may be implemented as anapplication in a device such as the iPhone. The application is sinstalled onto the phone and the user goes though a setup process(setting which sides are permissible, the length of time between turns,how the alerts are patterned, an automatic phone number that should becalled if the patient has not turned, a URL that the unit may need toaccess (if the phone's web browser is used to access a server), patientidentification data, permissible caregivers identification, and thelike. The caregiver then attaches to the patient one or more “holder”bandages, e.g., at position(s) instructed by a physician, nurse or otherpractitioner. The holder receives a sensor unit (such as describedabove) and that has been charged. This approach reduces sterilizationconcerns. The sensor is turned on and is placed in the pocket on theupper surface of the bandage which is already attached to the patient.It is assumed that the bandages would be changed frequently, perhaps asoften as the sensors are exchanged for charging. In one variant, thebandage contains a small magnet s integrated into the bandage, which,when in proximity to the sensor, turned the sensor on. This model hasthe attractive feature that the battery is only used when the sensor isin a bandage. The bandage is the on/off switch. Another variant is touse a separate antenna and reusable sensor. For example the bandageitself contains the antenna and the sensor “speaks” to the bandage,which then transmits to the phone via its antenna. Another alternativeis to use known RFID tags and sensors. In the home care embodiment, the“local” devices may be connected to one or more remote monitoring andalert systems to facilitate the care protocol.

The disclosed subject matter provides numerous advantages. Every year,untold amounts of unnecessary suffering are endured and medicalresources spent on care for pressure ulcers, an injury that could beprevented. This above-described monitoring system and method tracks thepatient's position over time and ensures that proper turning is donewithin the time prescribed. At present, there are no products availablewhich continuously monitor patient position and alert medical or otherpersonnel of the need for turning.

The disclosed subject matter (or components of the system) may beimplemented with any known or later-developed wireless and computernetworking technologies. Thus, for example, the wireless infrastructureillustrated above may include any wireless client device, e.g., a cellphone, pager, a personal digital assistant (PDA, e.g., with GPRS NIC), amobile computer with a smart phone client, or the like. A typical mobiledevice is a wireless access protocol (WAP)-enabled device that iscapable of sending and receiving data in a wireless manner using thewireless application protocol. The wireless application protocol (“WAP”)allows users to access information via wireless devices, such as mobilephones, pagers, two-way radios, communicators, and the like. WAPsupports wireless networks, including CDPD, CDMA, GSM, PDC, PHS, TDMA,FLEX, ReFLEX, iDEN, TETRA, DECT, DataTAC, and Mobitex, and it operateswith many handheld device operating systems, such as PalmOS, EPOC,Windows CE, FLEXOS, OS/9, and JavaOS. Typically, WAP enabled devices usegraphical displays and can access the Internet (or other communicationnetwork) on so-called mini- or micro-browsers, which are web browserswith small file sizes that can accommodate the reduced memoryconstraints of handheld devices and the low-bandwidth constraints of awireless networks. In addition to a conventional voice communication, agiven mobile device can communicate with another such device via manydifferent types of message transfer techniques including SMS (shortmessage service), enhanced SMS (EMS), multi-media message (MMS), e-mailWAP, paging, or other known or later-developed wireless formats.

The patient device described herein may be implemented using any knownor later developed RFID technologies. Such technologies are well-knownand may be used for the patient wearable device and associated readers.As is well-known, radio frequency identification (RFID) is an automaticidentification method that relies on storing and remotely retrievingdata using devices called RFID tags or transponders. As used herein, anRFID tag is an object that can be attached to or incorporated into aproduct or person for the purpose of identification using radio waves.The RFID tags may be active (internally powered) or passive (powered bythe received RF energy). Any commercial RFID tags and RFID systems forworkflow and inventory management may be used for this purpose.

The other components illustrated comprise a set of one or morecomputing-related entities (systems, machines, process programs,libraries, functions or the like) that together facilitate or providethe inventive functionality described. In a typical implementation, theinfrastructure comprises a set of one or more computers. Arepresentative machine is a network-based server running commodity (e.g.Pentium-class) hardware, an operating system (e.g., Linux, Windows,OS-X, or the like), an application runtime environment (e.g., Java,.ASP) and a set of applications or processes (e.g., Java applets orservlets, linkable libraries, native code, or the like, depending onplatform), that provide the functionality of a given system orsubsystem. The service may be implemented in a standalone server, oracross a distributed set of machines. Typically, a server connects tothe publicly-routable Internet, a corporate intranet, a private network,or any combination thereof, depending on the desired implementationenvironment. Of course, any other hardware, software, systems, devicesand the like may be used. More generally, the present invention may beimplemented with any collection of autonomous computers (together withtheir associated software, systems, protocols and techniques) linked bya network or networks. As previously noted, the hardware and softwaresystems in which the invention is illustrated are merely representative.The invention may be practiced, typically in software, on one or moremachines. Generalizing, a machine typically comprises commodity hardwareand software, storage (e.g., disks, disk arrays, and the like) andmemory (RAM, ROM, and the like).

The particular machines used in the network are not a limitation of thedisclosed subject matter. A given machine includes network interfacesand software to connect the machine to a network in the usual manner.While given components of the system have been described separately, oneof ordinary skill will appreciate that some of the functions may becombined or shared in given instructions, program sequences, codeportions, and the like.

Communications between the various devices and stations described abovepreferably are secured using known technologies.

While the above describes a particular order of operations performed bycertain embodiments, it should be understood that such order isexemplary, as alternative embodiments may perform the operations in adifferent order, combine certain operations, overlap certain operations,or the like. References in the specification to a given embodimentindicate that the embodiment described may include a particular feature,structure, or characteristic, but every embodiment may not necessarilyinclude the particular feature, structure, or characteristic.

Having described our invention, what we now claim is as follows.

1. A monitoring system, comprising: a sensor adapted to be carried by apatient and outputting spatial information associated with the patient'sphysical orientation; a monitor in communication with the sensor toreceive the spatial information together with temporal information, themonitor using the spatial and temporal information to determine whetherthe patient is following a patient turn protocol; and a device to outputa notification if the patient turn protocol is not being followed sothat remedial action can be initiated.
 2. The monitoring system asdescribed in claim 1 wherein the monitor comprises a bedside receivingstation.
 3. The monitoring system as described in claim 2 wherein thebedside receiving station is a intelligent mobile device.
 4. Themonitoring system as described in claim 1 wherein the monitor comprisesan attendant receiving station.
 5. The monitoring system as described inclaim 1 wherein the sensor is in communication with the monitor over awireless link.
 6. The monitoring system as described in claim 1 whereinthe sensor is self-powered.
 7. The monitoring system as described inclaim 1 wherein the spatial information is one of: a currentorientation, a change in the patient's orientation, a magnitude of achange in orientation, a frequency of a change in the patient'sorientation, and one or more allowed or disallowed positions.
 8. Themonitoring system as described in claim 1 wherein the temporalinformation is one of: a start time, a time since a last turn, a timeuntil a next turn, and a current or elapsed time.
 9. The monitoringsystem as described in claim 1 wherein the notification output by thedevice is an alarm.